Registered Nurse and Nursing Career Overview
Registered nurses (RNs) work to promote health, prevent disease, and help patients cope with illness. They are advocates and health educators for patients, families, and communities. When providing direct patient care, they observe, assess, and record symptoms, reactions, and progress in patients; assist physicians during surgeries, treatments, and examinations; administer medications; and assist in convalescence and rehabilitation. RNs also develop and manage nursing care plans, instruct patients and their families in proper care, and help individuals and groups take steps to improve or maintain their health. While State laws govern the tasks that RNs may perform, it is usually the work setting that determines their daily job duties.
Hospital nurses form the largest group of nurses. Most are staff nurses, who provide bedside nursing care and carry out medical regimens. They also may supervise licensed practical nurses and nursing aides. Hospital nurses usually are assigned to one department, such as surgery, maternity, pediatrics, the emergency room, intensive care, or the treatment of cancer patients. Some may rotate among departments.
Office nurses care for outpatients in physicians’ offices, clinics, ambulatory surgical centers, and emergency medical centers. They prepare patients for, and assist with, examinations; administer injections and medications; dress wounds and incisions; assist with minor surgery; and maintain records. Some also perform routine laboratory and office work.
Nursing care facility nurses manage care for residents with conditions ranging from a fracture to Alzheimer’s disease. Although they often spend much of their time on administrative and supervisory tasks, RNs also assess residents’ health, develop treatment plans, supervise licensed practical nurses and nursing aides, and perform invasive procedures, such as starting intravenous fluids. They also work in specialty-care departments, such as long-term rehabilitation units for patients with strokes and head injuries.
Home health nurses provide nursing services to patients at home. RNs assess patients’ home environments and instruct patients and their families. Home health nurses care for a broad range of patients, such as those recovering from illnesses and accidents, cancer, and childbirth. They must be able to work independently and may supervise home health aides.
Public health nurses work in government and private agencies, including clinics, schools, retirement communities, and other community settings. They focus on populations, working with individuals, groups, and families to improve the overall health of communities. They also work with communities to help plan and implement programs. Public health nurses instruct individuals, families, and other groups regarding health issues such as preventive care, nutrition, and childcare. They arrange for immunizations, blood pressure testing, and other health screening. These nurses also work with community leaders, teachers, parents, and physicians in community health education.
Occupational health nurses, also called industrial nurses, provide nursing care at worksites to employees, customers, and others with injuries and illnesses. They give emergency care, prepare accident reports, and arrange for further care if necessary. They also offer health counseling, conduct health examinations and inoculations, and assess work environments to identify potential or actual health problems.
Head nurses or nurse supervisors direct nursing activities, primarily in hospitals. They plan work schedules and assign duties to nurses and aides, provide or arrange for training, and visit patients to observe nurses and to ensure that the patients receive proper care. They also may ensure that records are maintained and equipment and supplies are ordered.
At the advanced level, nurse practitioners provide basic, primary healthcare. They diagnose and treat common acute illnesses and injuries. Nurse practitioners also can prescribe medications—but certification and licensing requirements vary by State. Other advanced practice nurses include clinical nurse specialists, certified registered nurse anesthetists, and certified nurse midwives. Advanced practice nurses must meet educational and clinical practice requirements beyond the basic nursing education and licensing required of all RNs.
Most nurses work in well-lighted, comfortable healthcare facilities. Home health and public health nurses travel to patients’ homes, schools, community centers, and other sites. Nurses may spend considerable time walking and standing. Patients in hospitals and nursing care facilities require 24-hour care; consequently, nurses in these institutions may work nights, weekends, and holidays. RNs also may be on call—available to work on short notice. Office, occupational health, and public health nurses are more likely to work regular business hours. More than 1 in 5 RNs worked part time in 2002 and nearly 1 in 10 held more than one job.
Nursing has its hazards, especially in hospitals, nursing care facilities, and clinics, in all three of which nurses may care for individuals with infectious diseases. Nurses must observe rigid standardized guidelines to guard against disease and other dangers, such as those posed by radiation, accidental needle sticks, chemicals used to sterilize instruments, and anesthetics. In addition, they are vulnerable to back injury when moving patients, shocks from electrical equipment, and hazards posed by compressed gases.
Registered Nurse (RN) and Nursing Training and Job Qualifications
In all States and the District of Columbia, students must graduate from an approved nursing program and pass a national licensing examination in order to obtain a nursing license. Nurses may be licensed in more than one State, either by examination, by the endorsement of a license issued by another State, or through a multi-State licensing agreement. All States require periodic renewal of licenses, which may involve continuing education.
There are three major educational paths to registered nursing: a bachelor’s of science degree in nursing (BSN), an associate degree in Nursing (ADN), and a diploma. BSN programs, offered by colleges and universities, take about 4 years to complete. In 2002, 678 nursing programs offered degrees at the bachelor’s level. ADN programs, offered by community and junior colleges, take about 2 to 3 years to complete. About 700 RN programs in 2002 were at the ADN level. Diploma programs, administered in hospitals, last about 3 years. Only a small and declining number of programs offer diplomas. Generally, licensed graduates of any of the three types of educational programs qualify for entry-level positions as staff nurses.
Many ADN- and diploma-educated nurses later enter bachelor’s programs to prepare for a broader scope of nursing practice. Often, they can find a staff nurse position and then take advantage of tuition reimbursement benefits to work toward a BSN by completing one of many RN-to-BSN programs.
Accelerated BSN programs also are available for individuals who have a bachelor’s or higher degree in another field and who are interested in moving into nursing. In 2002, more than 110 of these programs were available. Accelerated BSN programs last 12 to 18 months and provide the fastest route to a BSN for individuals who already hold a degree. Accelerated master’s degree programs in nursing also are available and take about 3 years to complete.
Individuals considering nursing should carefully weigh the advantages and disadvantages of enrolling in a BSN program, because, if they do, their advancement opportunities usually are broader. In fact, some career paths are open only to nurses with bachelor’s or advanced degrees. A bachelor’s degree often is necessary for administrative positions and is a prerequisite for admission to graduate nursing programs in research, consulting, teaching, or a clinical specialization.
Nursing education includes classroom instruction and supervised clinical experience in hospitals and other healthcare facilities. Students take courses in anatomy, physiology, microbiology, chemistry, nutrition, psychology and other behavioral sciences, and nursing. Course work also includes the liberal arts. Supervised clinical experience is provided in hospital departments such as pediatrics, psychiatry, maternity, and surgery. A growing number of programs include clinical experience in nursing care facilities, public health departments, home health agencies, and ambulatory clinics.
Nurses should be caring, sympathetic, responsible, and detail oriented. They must be able to direct or supervise others, correctly assess patients’ conditions, and determine when consultation is required. They need emotional stability to cope with human suffering, emergencies, and other stresses. Experience and good performance can lead to promotion to more responsible positions. In management, nurses can advance to assistant head nurse or head nurse and, from there, to assistant director, director, and vice president. Increasingly, management-level nursing positions require a graduate or an advanced degree in nursing or health services administration. They also require leadership, negotiation skills, and good judgment. Graduate programs preparing executive-level nurses usually last about 2 years.
Within patient care, nurses can move into a nursing specialty such as clinical nurse specialist, nurse practitioner, certified nurse midwife, or certified registered nurse anesthetist. These positions require about 2 years of graduate education leading to a master’s degree.
Some nurses move into the business side of health care. Their nursing expertise and experience on a healthcare team equip them with the ability to manage ambulatory, acute, home health, and chronic care services. Employers—including hospitals, insurance companies, pharmaceutical manufacturers, and managed care organizations, among others—need RNs for health planning and development, marketing, consulting, policy development, and quality assurance. Other nurses work as college and university faculty or conduct research.
Registered Nurse (RN) and Nursing Job and Employment Opportunities
Job opportunities for RNs are expected to be very good. Employment of registered nurses is expected to grow faster than the average for all occupations through 2012, and because the occupation is very large, many new jobs will result. In fact, more new jobs are expected be created for RNs than for any other occupation. Thousands of job openings also will result from the need to replace experienced nurses who leave the occupation, especially as the median age of the registered nurse population continues to rise.
Faster-than-average growth will be driven by technological advances in patient care, which permit a greater number of medical problems to be treated, and an increasing emphasis on preventive care. In addition, the number of older people, who are much more likely than younger people to need nursing care, is projected to grow rapidly.
Employers in some parts of the country are reporting difficulty in attracting and retaining an adequate number of RNs, due primarily to an aging RN workforce and insufficient nursing school enrollments. Imbalances between the supply of, and demand for, qualified workers should spur efforts to attract and retain qualified RNs. For example, employers may restructure workloads, improve compensation and working conditions, and subsidize training or continuing education. Employment in hospitals, the largest sector, is expected to grow more slowly than in most other healthcare sectors. While the intensity of nursing care is likely to increase, requiring more nurses per patient, the number of inpatients (those who remain in the hospital for more than 24 hours) is not likely to increase much. Patients are being discharged earlier and more procedures are being done on an outpatient basis, both inside and outside hospitals. Rapid growth is expected in hospital outpatient facilities, such as those providing same-day surgery, rehabilitation, and chemotherapy.
An increasing proportion of sophisticated procedures, which once were performed only in hospitals, are being performed in physicians’ offices and in outpatient care centers, such as freestanding ambulatory surgical and emergency centers. Accordingly, employment is expected to grow faster than average in these places as healthcare in general expands.
Employment in nursing care facilities is expected to grow faster than average due to increases in the number of elderly, many of whom require long-term care. In addition, the financial pressure on hospitals to discharge patients as soon as possible should produce more admissions to nursing care facilities. Job growth also is expected in units that provide specialized long-term rehabilitation for stroke and head injury patients, as well as units that treat Alzheimer’s victims.
Employment in home healthcare is expected to increase rapidly in response to the growing number of older persons with functional disabilities, consumer preference for care in the home, and technological advances that make it possible to bring increasingly complex treatments into the home. The type of care demanded will require nurses who are able to perform complex procedures.
In evolving integrated healthcare networks, nurses may rotate among various employment settings. Because jobs in traditional hospital nursing positions are no longer the only option, RNs will need to be flexible. Opportunities should be excellent, particularly for nurses with advanced education and training.
Historical Earnings Information
Median annual earnings of registered nurses were $48,090 in 2002. The middle 50 percent earned between $40,140 and $57,490. The lowest 10 percent earned less than $33,970, and the highest 10 percent earned more than $69,670. Median annual earnings in the industries employing the largest numbers of registered nurses in 2002 were as follows:
Many employers offer flexible work schedules, childcare, educational benefits, and bonuses.